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General NPI Number Information
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NPI Number | 1982412151
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Entity Type | Individual
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Provider Name | EMMA WYATT CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 22 OLD WATERBURY RD
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City | SOUTHBURY
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State | CT
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Zip | 06488-3848
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Country | US
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Telephone | 203-262-4230
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MAIN ST
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City | NEWTOWN
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State | CT
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Zip | 06470-2132
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Country | US
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Telephone | 508-561-7240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7942
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License Number State | CT
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